Healthcare Provider Details

I. General information

NPI: 1518870849
Provider Name (Legal Business Name): MD SEA TO SEA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2026
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 N MOUNT JULIET RD STE 100
MT JULIET TN
37122-4287
US

IV. Provider business mailing address

819 N BRAGG AVE
LOOKOUT MOUNTAIN TN
37350-1003
US

V. Phone/Fax

Practice location:
  • Phone: 760-809-4267
  • Fax: 858-500-1812
Mailing address:
  • Phone: 760-809-4267
  • Fax: 858-500-1812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. BRYAN LONG
Title or Position: PRESIDENT
Credential: MD, MPH
Phone: 760-809-4267